I recently came across this talk by Michael Porter about healthcare that he had delivered at Harvard Business School though the talk was generally about the healthcare system in the US however i felt that it was quite relevant to healthcare systems in general across the globe.
One of the most important things that he talked about was Value Creation and improving the Value delivery system. But then the question which arises is what is the true value. How do we define Value becomes critical , is it just patient outcomes , is it cost of delivery , could it be a generalised figure and he defines it quite comprehensively he says that it the patient health outcomes achieved relative to the money spent to achieve those outcomes. Which becomes a simplified outcomes as numerator and cost as denominator.
This is quite a shift in our existing way of measuring success which are either based around profit maximisation, or Volume delivered, or access to healthcare in general. Quality as it stands currently is based entirely around the process definition and improvement. Be it any guideline we follow NABH or JCI its mostly process based. Process improvement is very important however outcomes are even more important. And are we really measuring the clinical outcomes. If the system is to improve then the competition has to move from being profit or process based to becoming outcome based and then to value creation and thats the only way we can get a handle on the spiralling costs of healthcare delivery.
So how do we really shift the focus to value.
Lets Look at Outcomes outcomes need to defined per patient and his / her medical condition. We need to look at survival, functional status, independence, residual defect / illness. Yes it is an intensive exercise but the results would truly be enlightening and a true move towards the goal of quality. Define the Outcome parameters for any surgery / medical treatment that is meted out including survival rates, extension of survival period, dependence of medication etc etc.
Secondly identify your costs. For some strange reason healthcare seems to shy away from a practice which is so commonly followed in the manufacturing sector and this is ABC (Activity based Costing ) .For Healthcare i would suggest a time related Activity based costing. Whats even more specific is that it will be a patient based time related activity based costing. We tend to see ourselves as distinct departments and subunits and we tend to do our costings similarly too(that is if we do our costings). However a true costing exercise must capture the entire cost related to the patients journey through care pathways. And through this way we should be able to define the true value of a patient outcome. The focus needs to be on the Outcome , and existing technology in terms of HIS systems must integrate these costing parameters but the end result could truly be transformational .
I personally look forward to a day where we will focus on the right performance indicators though that is a different post in itself. But i think this could very well be a move in the right direction be it for a private hospital, a charitable trust or a public trust. Efficiency , effectiveness both would be effectively measured and documented and true value would lead to better profits / access/ volumes so this is a win win no matter which way you take it.
Here is the Video if you are interested , apologies for the poor sound quality.
Disclaimer: The views expressed in this post are my own and are not meant to be derogatory to any institution or organisation. These are just my thoughts and these are open for further discussion and development. Please do comment and share and let’s get some universal cognition into this. Thank you for your patience and tolerance.